Low Histamine Diet for Histamine Intolerance: Symptoms, Foods to Avoid and How to Reintroduce Them.
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Headaches after a glass of red wine. Flushing after aged cheese. A runny nose, an itchy rash or a racing heart that seems to come out of nowhere after dinner. If your symptoms are this varied and this hard to pin down, histamine may be part of the story. In this guide I'll explain what histamine intolerance is, what the evidence does and doesn't say, and how to run a low histamine trial properly, including the reintroduction step that keeps your diet from shrinking for no reason.
What is histamine?
Histamine is a compound your body makes from the amino acid histidine. It's stored mainly in mast cells and certain white blood cells, and released when it's needed. It's also found in food, especially anything fermented, aged, cured or not quite fresh.1
- Immune defense. Histamine widens blood vessels and makes them leakier, so immune cells can reach an injury or infection quickly. That's where the redness, swelling and itching of an allergic reaction come from.1
- Stomach acid. Histamine signals the cells in your stomach lining to release acid. It isn't part of the acid itself, which is why some acid-reducing medications work by blocking histamine's receptor in the stomach.1
- Brain. As a neurotransmitter, histamine helps keep you awake and alert, which is why older antihistamines make people drowsy.1
- Muscle tone. Histamine contracts smooth muscle in the airways and gut, which can mean wheezing or faster bowel movements when there's too much of it.2
So the goal is never to get rid of histamine. It's to keep it in balance.
What is histamine intolerance?
Histamine intolerance is when histamine builds up faster than your body can break it down, usually because the gut enzyme diamine oxidase (DAO) can't keep up with what's coming in. Unlike an allergy, it isn't driven by IgE antibodies, and how much you react depends on your total histamine load rather than a single food. It's estimated to affect around 1% of people, but nobody knows for sure, because there's still no reliable test.2,3
Think of it as a bucket. Histamine flows in from food and from your own cells. Two enzymes drain it: DAO, which works in the gut lining and handles histamine from food, and histamine N-methyltransferase (HNMT), which works inside cells.2 When the inflow is too high or the drain is too slow, the bucket overflows and you get symptoms.
- Histamine-rich foods: fermented, aged, cured, leftovers
- Liberators: foods that make your own cells release histamine
- Other amines, like putrescine, that compete for DAO
- DAO in the gut lining
- HNMT inside cells
- Flushing, itching, hives
- Headaches, congestion
- Gut symptoms, racing heart
I want to be upfront about the evidence. A guideline from the German, Swiss and Austrian allergy societies concludes that the science linking ingested histamine to symptoms is limited and contradictory, and that symptoms often don't reproduce when people are tested under controlled conditions.3 That doesn't mean your symptoms aren't real. It means "histamine intolerance" may be a label for several overlapping problems, and that a careful, time-limited trial tells you more than any list on the internet.
Histamine intolerance or mast cell activation? In mast cell activation syndrome (MCAS), the problem is the opposite end of the bucket: mast cells release too much histamine and other chemicals. The symptoms overlap heavily, and the Swiss Interest Group Histamine Intolerance (SIGHI) believes many people with histamine problems actually have a mast cell disorder.4 MCAS needs a medical diagnosis, but the dietary approach is similar, with extra attention to histamine liberators.
Symptoms of histamine intolerance
Because histamine receptors are found throughout the body, symptoms can show up almost anywhere. The most commonly reported include:2
- Flushing
- Itching or hives
- Headaches and migraines
- Runny or blocked nose, sneezing
- Diarrhea, bloating or cramps
- Nausea
- Fast or irregular heartbeat
- Low blood pressure, dizziness
- Wheezing or asthma-like symptoms
- Watery, itchy eyes
In practice, people also describe anxiety, poor sleep, motion sickness or unusually big reactions to insect bites. These fit with what histamine does in the body, but they're less well documented. Symptoms are often delayed, dose-dependent and inconsistent: the same meal can cause trouble one day and nothing the next, depending on stress, sleep, hormones and what else you ate.4
When to see a doctor first
Swelling of the lips, tongue or throat, difficulty breathing, or fainting after eating is an emergency, not a diet question. Please also see your doctor before changing your diet if you have blood in your stool, unexplained weight loss, persistent diarrhea or ongoing skin reactions. Food allergies, celiac disease, inflammatory bowel disease and other conditions can look a lot like histamine intolerance and need to be ruled out first.3
What causes histamine intolerance?
Histamine intolerance is rarely about histamine alone. It's about the balance between how much comes in and how well you clear it. These are the factors I look at:
Reduced DAO activity in the gut
DAO is made in the cells lining your small intestine, so conditions that inflame or damage that lining, such as inflammatory bowel disease or celiac disease, can lower it.1,2 This is one reason histamine intolerance often shows up alongside other gut problems, and why it can improve when the gut heals.
Medications and alcohol
Some medications block DAO or trigger histamine release, including certain painkillers, antibiotics and heart medications. Alcohol is a triple threat: many drinks contain histamine, alcohol releases it, and it inhibits DAO.2 Please don't stop a prescribed medication on your own. If you suspect one is involved, ask your doctor or pharmacist about alternatives.
Your total histamine load
Histamine-rich foods, liberators and other biogenic amines all add to the bucket. Putrescine, found in foods like citrus fruit and bananas, competes with histamine for DAO, which may explain why some foods with little histamine still cause trouble.5
Genetics
Variants in the gene that codes for DAO have been linked to lower enzyme activity.1 HNMT relies on B vitamins and SAMe, the body's main methyl donor,6 so methylation may matter in theory. Direct evidence linking methylation genes like MTHFR to histamine intolerance is thin, though, so I wouldn't read too much into a single gene result.
Nutrient status
DAO is a copper-containing enzyme, and low levels of copper, vitamin C and vitamin B6 have all been linked to reduced DAO activity.7,6 I cover these in the supplements section.
Is there a test for histamine intolerance?
Not a reliable one. Blood tests for DAO activity are widely sold, but the allergy guideline concludes they're inconclusive and shouldn't be used on their own to diagnose or rule out histamine intolerance.3 In my experience, the most useful approach is to rule out other causes with your doctor, then run a structured trial: remove histamine-rich foods until symptoms settle, and reintroduce them to see whether they come back.4 If symptoms return when you reintroduce several histamine-rich foods, that tells you far more than a single blood test.
How to follow a low histamine diet
Step 1: Elimination (2 to 6 weeks)
Remove histamine-rich foods, histamine liberators and DAO blockers. SIGHI recommends following the diet for at least two weeks, and ideally four to six, until you're symptom-free, ideally without taking extra antihistamines or supplements, so you can tell whether it's the diet that's working. Please check with your doctor before stopping any prescribed medication.4 There's no need to go longer before reintroducing. Freshness matters as much as the food itself: histamine forms as protein foods age, so fresh fish and meat are tolerated far better than aged, cured or leftover versions.1
High-histamine (or high-amine) foods:
- All alcohol: beer, wine, spirits
- Fermented and pickled foods: sauerkraut, kimchi, pickled onions, kefir, kombucha
- Fermented condiments: soy sauce, tamari, fish sauce, wine, balsamic and apple cider vinegar
- Aged cheese: hard and semi-hard cheeses
- Cured, smoked, canned or marinated meat and fish
- Certain vegetables: spinach, eggplant, tomato, avocado
- Certain fruits: banana, dried fruit, raspberries
- Long-proofed doughs and yeast extracts
- Many nuts and nut butters: almonds, peanuts
Histamine liberators trigger your own cells to release histamine, even if they contain little themselves:
- Citrus fruit, strawberries, pineapple, papaya, kiwi, plums
- Tomatoes
- Shellfish: crab, lobster, mussels, prawns, shrimp
- Cashews, walnuts, hazelnuts
- Beans and legumes, including soy and lentils
- Seaweed: kelp, kombu, nori, wakame
- Chocolate and cocoa
- Egg white
- Additives: MSG, benzoates, sulfites, nitrites, many food dyes
DAO blockers slow the enzyme that clears histamine:
- Alcohol
- Black, green and mate tea
- Energy drinks
A word of warning about food lists, including mine. A review of ten published low histamine diets found they disagreed on most foods. Only fermented foods were excluded by all of them, and only about a third of the excluded foods were actually high in histamine.5 Among non-fermented plant foods, only eggplant, spinach, tomato and avocado contain significant histamine.8 The rest are on lists because they're liberators, contain competing amines, or because people report reacting to them. That's why the reintroduction step matters so much.
Take the guesswork out of it
My Printable Low Histamine Food List sorts foods using the scoring system of the Swiss Interest Group Histamine Intolerance (SIGHI), release 29.08.2024, one of the most detailed food compatibility lists available.4 YES foods have a SIGHI score of 0 and are usually well tolerated. NO foods have a score of 1 to 3 and include medium to high histamine foods, histamine liberators and DAO blockers, so you don't have to cross-check three lists. Everything fits on a single page, so it doubles as your grocery list.
Get the Low Histamine Food List
Practitioner? You're welcome to print it as a handout for your clients.
Step 2: Reintroduction
Once your symptoms have settled, start bringing foods back one at a time. Choose foods from different groups, start with the ones you miss most, and have a normal portion. Then wait one to two days, eating only foods you know you tolerate, before testing the next one, because reactions can be delayed.4 If you react, wait until symptoms have fully settled before moving on.
Tolerance is dose-dependent, so a food that causes symptoms in a large portion may be fine in a small one. It also tends to improve over time, so foods you react to now are worth retesting in a few months.4 The goal is the widest diet you can tolerate, not the strictest one you can survive. The allergy guideline specifically warns against people restricting their diet for years without good reason.3
Tracking makes this far easier. Write down what you ate, how much, and any symptoms over the following 48 hours. A simple symptom and food tracker makes patterns easier to spot, and if your symptoms are mostly digestive, the version with a stool tracker lets you log those too.
Supplements that may help
DAO enzyme
DAO supplements, usually made from pig kidney, are taken before meals to help break down histamine from food in the gut. In a randomized double-blind trial in people with migraine and low DAO activity, one month of DAO shortened migraine attacks compared with placebo, although the authors described it as a positive trend and called for longer studies.9 In a small open-label study of 28 people with histamine intolerance, symptoms improved while taking DAO and returned after stopping.10 These are encouraging but small studies. DAO can help with flexibility, like eating out, but it isn't a substitute for the diet.
Legume sprouts are one to watch. They contain far more DAO than unsprouted seeds, around 250 times more according to one review,6 and researchers are developing freeze-dried sprouts as a plant-based DAO supplement.7 Whether eating sprouts at home raises your own DAO activity hasn't been tested, though, so I wouldn't rely on them yet.
Vitamin C
Vitamin C appears to lower histamine in more than one way: it may calm mast cells, help DAO break histamine down, and reduce how much histamine the body makes.11 In a small study of 10 healthy adults, taking 2 g of vitamin C a day for two weeks lowered blood histamine by 38%.12 That wasn't done in people with histamine intolerance, so I'd start by eating more low histamine fruit and vegetables, and discuss a supplement with a practitioner, as high doses don't suit everyone. SIGHI also flags ascorbic acid as a weak DAO inhibitor and suggests supplements may suit MCAS better than histamine intolerance,17 which is another reason to start with food.
Copper and vitamin B6
Copper is part of the DAO enzyme,1 and some authors suggest copper or vitamin B6 supplements as an optional extra alongside the diet.7 It's worth checking your levels rather than supplementing blindly, as copper in particular can cause problems in excess.
Probiotics: proceed with care
Some bacteria make histamine, others break it down, and this varies by strain, not just species. Lactobacillus saerimneri 30a, a potential probiotic, produces significant amounts of histamine, and in a lab screening of 15 lactic acid bacteria, two strains, L. casei TISTR 389 and L. bulgaricus TISTR 895, looked capable of producing it. L. reuteri shows how much the strain matters: a few strains, such as ATCC PTA 6475, can make histamine,13 while the widely used DSM 17938 lacks the genes to do so. And L. plantarum D-103 broke down histamine in lab tests.7 Lab research also suggests Lactobacillus rhamnosus GG may calm mast cell activity.14 So far there are no clinical trials of probiotics in histamine intolerance,7 so if you try one, choose a specific, well-researched strain, introduce it on its own and track your symptoms. Fermented foods aren't a shortcut here, as they're among the highest-histamine foods there are.
Cooking and lifestyle
- Boil rather than grill or fry. In one study, grilling roughly doubled the histamine in mackerel, while boiling had little effect or lowered levels in the foods tested.15
- Eat fresh, and freeze leftovers fast. Histamine builds up as food ages, especially fish and meat.1 Cool cooked food quickly and freeze portions rather than keeping them in the fridge for days.
- Mind your threshold. Stress, poor sleep, excessive physical strain, smoke and air pollution can all lower how much histamine you tolerate on a given day.4 This is why the same meal can affect you differently on holiday and in a busy work week.
- Notice how you react to sun. In lab research on human skin mast cells, UV light caused a small histamine release from resting cells but strongly suppressed release once the cells were triggered.16 That may help explain why some people flare in the sun while UV therapy helps others with itchy skin conditions.
- Take a break from alcohol. It adds histamine, releases more and blocks DAO at the same time.2
Frequently asked questions
How long should I follow a low histamine diet?
Usually two to six weeks for the elimination phase, or until your symptoms settle, followed by a structured reintroduction. It's designed as a test, not a permanent diet. Staying on a strict version for months without reintroducing foods risks nutrient gaps and an unnecessarily narrow diet.
Is there a test for histamine intolerance?
There's no reliable lab test. Blood tests for DAO activity are available, but current allergy guidelines consider them inconclusive. The most informative approach is to rule out other conditions with your doctor, then do an elimination and reintroduction trial and track your symptoms.
Is histamine intolerance the same as an allergy?
No. A food allergy involves IgE antibodies and can be triggered by tiny amounts of a specific food. Histamine intolerance is about the total amount of histamine compared with your ability to break it down, so reactions are dose-dependent and can vary from day to day.
What's the difference between histamine intolerance and MCAS?
In histamine intolerance, the main problem is breaking histamine down. In mast cell activation syndrome (MCAS), mast cells release too much histamine and other chemicals. The symptoms overlap and both can respond to a low histamine diet, but MCAS needs a medical diagnosis and often medication.
Do DAO supplements work?
Early evidence is encouraging. A small randomized trial found DAO shortened migraine attacks in people with low DAO activity, though longer studies are needed, and a small open-label study found symptoms improved while people took it. They work best alongside a low histamine diet, for example when eating out, rather than instead of it.
Why do I react to a food one day but not the next?
Because histamine adds up. Your reaction depends on everything else in your bucket that day: other foods, alcohol, stress, sleep and hormones. The histamine content of a food also varies a lot depending on how fresh it is and how it was stored and cooked.
Why do low histamine food lists disagree?
A review of ten published low histamine diets found they excluded different foods. Only fermented foods were excluded by all of them. Lists mix foods that are high in histamine with liberators, DAO blockers and foods people report reacting to, and each source weighs these differently. That's why personal reintroduction matters more than any single list.
Is histamine intolerance permanent?
Not necessarily. Tolerance often improves over time, especially when an underlying cause like gut inflammation is addressed or a medication is changed. That's why it's worth retesting foods every few months rather than avoiding them forever.
Is a low histamine diet the same as a low sulfur or low FODMAP diet?
No. Each targets a different compound, and the food lists only partly overlap. A low FODMAP diet reduces fermentable carbohydrates, while a low sulfur diet reduces sulfur-rich foods. Some people need to explore more than one, but it's best to test them one at a time so you know which change made the difference.
The bottom line
Histamine intolerance is real for many people, but the science is still catching up, and there's no reliable test. A low histamine diet is best used as a short, structured experiment: remove histamine-rich foods for a few weeks, reintroduce them one by one, and keep only the restrictions that actually make a difference to you. The Printable Low Histamine Food List gives you everything you need to run the trial yourself.
References (16)
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- 2ReviewMaintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85(5):1185-1196. Source ↗
- 3Clinical guidelineReese I, Ballmer-Weber B, Beyer K, et al. Guideline on management of suspected adverse reactions to ingested histamine: guideline of the DGAKI, GPA, AeDA, SGAI and ÖGAI. Allergol Select. 2021;5:305-314. Source ↗
- 4Patient organizationSwiss Interest Group Histamine Intolerance (SIGHI). Therapy: dietary change. Updated July 20, 2020. Source ↗
- 5ReviewSánchez-Pérez S, Comas-Basté O, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Low-histamine diets: is the exclusion of foods justified by their histamine content? Nutrients. 2021;13(5):1395. Source ↗
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- 8ReviewSánchez-Pérez S, Comas-Basté O, Rabell-González J, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Biogenic amines in plant-origin foods: are they frequently underestimated in low-histamine diets? Foods. 2018;7:205. Source ↗
- 9RCTIzquierdo-Casas J, Comas-Basté O, Latorre-Moratalla ML, et al. Diamine oxidase (DAO) supplement reduces headache in episodic migraine patients with DAO deficiency: a randomized double-blind trial. Clin Nutr. 2019;38(1):152-158. Source ↗
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- 14Lab studyOksaharju A, Kankainen M, Kekkonen RA, et al. Probiotic Lactobacillus rhamnosus downregulates FCER1 and HRH4 expression in human mast cells. World J Gastroenterol. 2011;17(6):750-759. Source ↗
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- 16Lab studyGuhl S, Stefaniak R, Strathmann M, et al. Bivalent effect of UV light on human skin mast cells: low-level mediator release at baseline but potent suppression upon mast cell triggering. J Invest Dermatol. 2005;124(2):453-456.
- 17Patient organizationSwiss Interest Group Histamine Intolerance (SIGHI). Food compatibility list: histamine (release 29.08.2024). Source ↗
This article is for educational purposes only and isn't a substitute for personalized medical advice. Please talk to your doctor or a qualified practitioner before making significant changes to your diet or supplements. See my full medical disclaimer.
